Transformative learning in early-career child and adolescent psychiatry in the pandemic

The COVID-19 pandemic has globally affected the practice of child and adolescent psychiatry, as well as the daily lives of early-career child and adolescent psychiatrists. There have been changes in continuity of care (eg, postponed, cancelled, or online consultations, and few functioning inpatient units, with others becoming COVID-19 units) and the usual work frame (eg, facemasks, physical distancing, and not offering toys). Work shifted to creating standard operating procedures for care with safety precautions; disseminating advice and information about mental health; offering mental health support to frontline workers; and helping with duties outside of child and adolescent psychiatry. As early-career clinicians in child and adolescent psychiatry, we feared potential problems, such as increased risk of child abuse, domestic violence; behavioural crisis or suicide in adolescents who rely mostly on peer support and their social life; diagnostic delays (eg, for neurodevelopmental disorders); and parental burn-out (as the only caregivers).¹ The fear of infection reduced emergency visits, but probably made these at-risk families inaccessible to clinicians.

Except for emergency services, most clinical work has now shifted to online platforms. Many clinicians who were not familiar enough with technology were unable to reach and engage with patients and families or sense their mood. Face-to-face assessments were made challenging by masks hiding facial expressions, which are key for engaging in child and adolescent psychiatry. Assessing toddlers and young children was almost impossible, because they found it hard to cooperate with online means of communication.² Novel strategies seemed to help, such as asking parents to send in videos of children before a consultation to show them in natural settings, engaged in play, speaking, engaged in social communication, and with minimal toys and no screen (50–60% were able to send videos, which helped clinical interpretation). Online means of communication—either through parents or directly—mostly worked for older children and adolescents. Although excessive technology use and stress due to excess time indoors (eg, in the case of ADHD or conduct disorder) increased, some adolescents enjoyed teleconsultation because of its lack of outside stress, and requested to continue care in this way; this was often adolescents who refuse school, experience bullying, or have agoraphobia. Despite the best efforts, however, the digital divide concerning knowledge, access, and, resources limit the utility of such services.³

The fall in the number of clinic visits has affected community research. Meeting deadlines, completing studies, and ensuring timely staff payments are challenging.⁴ Attempting to move ongoing assessments, training, and interview-based research methods to online platforms was challenging, including navigating ethical concerns, but was nevertheless a learning experience.

The pandemic has opened the way for new, innovative research questions concerning such topics as the lived, home experiences of people with ADHD, online therapies for autism and anxiety (for patients with difficulties in social situations), description of an at-risk population (eg, young students living alone in large cities), and telepsychiatry.The pandemic has led to a major shift in child and adolescent psychiatry service delivery and research. As early-career child and adolescent psychiatry professionals, we propose it is time to convert these challenges into opportunities, potentially by designing novel methods using technology, service decentralisation in low-resource settings, increasing community awareness, and bolstering research for the sustenance and advancement of child and adolescent psychiatry.